Surgical course
The implemented epicardial leads were either unipolar
non-steroid-eluting or bipolar steroid-eluting. The type of epicardial
lead to be applied for a patient was selected based on the preference
and experience of the surgeon, discussion with electrophysiology team,
and availability of the lead. Regarding availability of the leads, it
should be noted that bipolar steroid-eluting leads were less available
in recent years in Iran due to the sanctions and being expensive.
However, since we enrolled all patients with epicardial lead
implantation and considered patient and lead factors in our multivariate
analysis, lead availability did not cuase a bias. Several surgeons
performed the surgeries, who are well experienced regarding lead
implementation. Epicardial leads were implanted through a midline
sternotomy, lateral thoracotomy, or subxiphoid approach. These
approaches were selected according to the patients’ cardiac anatomy and
position, their prior or concurrent operations.